Pap Ii Exam 2

Front 1

What is the breathing circuit?

Back 1

Lg, bore, corrugated hose that provides a flexible, low resistance, lightweight connection fr. one part of the system to another

Front 2

When do the gases enter the breathing circuit?

Back 2

After the gases fr the flow meters and vaporizor exit the AM at the CGO, they enter the breathing circuit.

Front 3

Is the scavenging system part of the breathing system?

Back 3

No, the breathing system ends at the point where gas would enter the scavenging system.

Front 4

Which breathing system has access to the atmosphere?

Back 4

The Open system

Front 5

Breathing circuits are classified and based on______.

Back 5

-Whether a reservior (breathing bag) is present
-Degree to which rebreathing occurs

Front 6

Name the four classifications of breathing circuits.

Back 6

Open, Semi-open, semi-closed, closed

Front 7

T/F In the closed system, low FGF and adjustable pressure valve, the rebreathing is total.

Back 7

True

Front 8

What is the difference between nonrebreathing systems and rebreathing systems?

Back 8

Nonrebreathing: exhaled gases containing C02 are removed from the system
Rebreathing: inhalation of previously respired gases fr which CO2 may or may not have been removed

Front 9

Is the amount of rebreathing proportionately or inversely related with the FGF?

Back 9

Rebreathing varies inversely; if volume of FG is equal to or greater than pt's minute volume, there will be no rebreathing, if FG is < min volume, some exhaled gases must be rebreathed to make up the total volume

Front 10

What are some examples of dead space?

Back 10

ETT, y-piece, volume within mask, humidification exchangers, etc

Front 11

T/F Rebreathing of exhaled gases occurs with the use of anesthesia breathing circuits.

Back 11

True

Front 12

What are three advantages of rebreathing?

Back 12

1. Increase in tracheal warmth
2. Increase in humidity
3.Decrease in potential for exposure of waste gases

Front 13

Higher FGF is_____ rebreathing in any type of circuit.

Back 13

less

Front 14

N2 slows/speeds up induction?

Back 14

slows, N2 that is not eliminated fr the circuit delays the establishment of the desired agent concentration, thus higher FGF would be needed

Front 15

In order to get the quickest composition of gas in the circuit to resemble that at the common gas outlet, should the FGF be higher or lower?

Back 15

Higher FGF=quick results of what dialed agent, N2O,O2 will be at CGO

Front 16

Why would rebreathing of exhaled agents during maintenance phase be beneficial?

Back 16

-Cost effective
-Environmentally friendly

Front 17

Using a higher FGF during emergence is appropriate because ______

Back 17

Reduces the discrepancies fr desired and actual concentrations

Front 18

Ventilator tidal volumes are set much higher than the volume of a spontaneous breath, why?

Back 18

To compensate for dead space, respiratory equipment has some degree of ds with results in rebreathing of some exhaled CO2.

Front 19

If Dead space increases acutley, one should avoid hypercapnia; what can be done?

Back 19

Increase the minute ventilation (VE)

Front 20

What would constitute the end of DS is a circle system?

Back 20

Y-piece. DS ends where inspiratory and expiratory streams diverge.

Front 21

Why do AM use dry gases?

Back 21

To avoid internal corrosion and bacterial colonization

Front 22

Do anesthetists use more passive or active humidification?

Back 22

Passive cause active is less effective at preventing hypothermia and added moisture can clog gas-analysis lines and soda lime granules, or obstruct unidirectional valves

Front 23

Would the concentration that is set on the vaporizor dial be the same as the actual concentrations in the circuit, lungs, blood, and brain?

Back 23

No, they vary over time d/t gradients of the gases

Front 24

When starting emergence, what should happen with the inspired concentrations?

Back 24

They should be decreased so gas is "washed" out while ventilation is continued

Front 25

What are 4 features that all nonrebreathing circuits possess?

Back 25

1. Lack of unidirectional valve
2. Lack soda lime CO2 absorption
3. amt of rebreathing is highly dependent on FGF
4. Amt of resistance is low

Front 26

Since Mapleson nonrebreathing circuits lack unidirectional valves and CO2 absorbers, where does the CO2 go?

Back 26

FGF must wash co2 out of the circuit via the CO2 washout circuits or flow-control breathing system

Front 27

Very important question: What year was letter F of the Mapleson system added?

Back 27

1975, of coarse! :-)

Front 28

What are 5 common components of the Mapleson System?

Back 28

1. Facemask
2. Spring-loaded pop off
3. Reservoir tubing
4. Fresh gas inflow tubing
5. Reservoir bag

Front 29

What functional groups do the Mapleson system contain?

Back 29

A, BC, DEF

Front 30

Which Mapleson system is the best for spontaneous ventilation?

Back 30

Mapleson A, it requires a FG inflow rate of only 1X VE to prevent rebreathing of CO2

Front 31

Which Mapleson system is the worst for controlled ventilation?

Back 31

Mapleson A, d/t VE required being as high as 20L/min to prevent rebreathing

Front 32

Mapleson BC is </> efficient than DEF, and why?

Back 32

< cause BC requires higher VE than DEF

Front 33

Where is the POV (spring loaded pop off valve) located in the Mapleson BC systems?

Back 33

near the facemask...FG inlet tubing is near pt

Front 34

In the Mapleson B&C system, the reservior tubing and breathing bag are a ____limb, and _____ occurs.

Back 34

blind limb, dead space occurs

Front 35

In the BC system, is the APL valve open or closed? When is excess gas vented?

Back 35

APL valve is open, excess gas is vented during exhalation

Front 36

How would one accomplish assisted or controlled ventilation in the BC system?

Back 36

Closing the APL valve sufficiently to allow the lungs to be inflated, excess gases are then vented during inspiration

Front 37

The Mapleson D, E, F are often referred to what?

Back 37

T-piece group, they function similarly

Front 38

Mapleson F, also called Jackson-Rees, is beneficial to use in comparison to DE, why?

Back 38

-Use very low resistance to breathing, can be used for any age
Should have FGF 2-3X VE to prevent rebreathing (min 5L/min)

Front 39

What are the 13 factors that affect CO2 rebreathing in Mapleson systems?

Back 39

1.FG inflow rate
2. minute ventilation
3.Mode of ventilation
4. Tidal volume
5. respiratory rate
6. co2 sample site
7. inspiratory to expiratory ratio
8. duration of expiratory pause
9 peak inspiratory flow
10. volume of reservoir tube
11. volume of breathing bag
12. ventilation by mask
13. ventilation through an ETT

Front 40

Choose the sequence that represents the best prevention of rebreathing during spontaneous ventilation in the Mapleson system.
a.DFE>A<cb
b. dfe>A>CB
c. A>DFE>CB

Back 40

C. A>DFE>CB

Front 41

What is the sequence of the Mapleson system that provides the greatest prevention of rebreathing during controlled ventilation.

Back 41

DEF>BC>A

Front 42

The most popular representative from the DEF group is what?

Back 42

Bain Circuit

Front 43

What is the Bain system used for?

Back 43

Spontaneous and controlled ventilation, FG inflow rate to prevent rebreathing is 2.5X VE.

Front 44

Prior to using the Bain system, what should you do and how?

Back 44

Test the circuit, use Pethick's test- detect faulty inner tubes in co-axial bain circle( plug it into o2 to check if there is flow)

Front 45

What are four advantages to the nonrebreathing system?

Back 45

1. Lightweight
2. Convenient
3. easily sterilized and scavenged
4. exhaled gases in corrugated limb may give heat and humidity to inhaled gas

Front 46

What are 4 disadvantages of the nonrebreathing system?

Back 46

1. Unrecognized disconnection or kinking of FG hose
2. Pollution and increased costs of agents and gases( using higher flows)
3. Loss of heat from pt
4. May require disconnection of circle FG supple hose and scavenger connections for assembly-could be reassembled wrong

Front 47

How does the Traditional Circle (universal F) breathing circuit prevent rebreathing of CO2?

Back 47

It uses CO2 absorbents, it allows partial rebreathing of other exhaled gases

Front 48

What are the 7 major components of the Traditional Breathing system?

Back 48

1. Fresh gas inflow source
2. inspiratory and expiratory unidirectional valves
3. inspiratory and expiratory corrugated tubes (limbs)
4. Y- piece connector
5. Overflow of APL valve
6. Reservoir bag
7. Canister containing CO2 absorbent

Front 49

What is the most common used Traditional breathing circuit and how does it work?

Back 49

The semi-closed, some rebreathing of exhaled gases occurs

Front 50

What is the purpose of the inspiratory and expiratory valves in the traditional breathing system?

Back 50

Ensures that gas flow through the corrugated hoses remains unidirectional

Front 51

To prevent rebreathing of CO2 in a traditional system, three rules must be followed. What are they?

Back 51

1. unidirectional valve must be located between the pt and reservoir bag on both the insp and exp limbs of circuit
2. FG infow cannot enter the circuit between the exp valve and the pt
3. overflow valve (APL) cannot be located between the pt and inspiratory valve

Front 52

Explain what the most efficient circle system would entail.

Back 52

It would have the highest concentration of fresh gases, unidirectional valves are near the pt and the APL is located just downstream of the expiratory valve. This minimized dead space gas and eliminated exhaled alveolar gas

Front 53

What are five advantages of the circle system.

Back 53

1. Constant inspired concentrations
2. conservation of respiratory tract heat and humidity
3. Minimal OR and environmental pullution
4. Useful for closed system, low flow, and semi flow configurations
5. low resistance

Front 54

Choose three causes for circle system obstruction.
Debris, manufacturing defects, turned off, leak near CGO, pt secretions

Back 54

Manufacturing defects, debris, pt secretions, obstruction fr other sources-albuterol neb

Front 55

Name 4 of the 6 disadvantages of the circle system.

Back 55

1. relatively complex
2. misconnect or disconnect
3. malfunctioning unidirectional valves
4. closed:occlusion
5. less portable
6. increased DS

Front 56

Why are CO2 absorbents important?

Back 56

Makes rebreathing of exhalations possible, conserves agent, gases, humidty, prevents resp acidosis

Front 57

What determines the amount of rebreathing in the circle system?

Back 57

The Gas flows set on the flow meters...FGF of .3-.5L/min provides near total rebreathing and full reliance on absorbent for prevention of rebreathing CO2

Front 58

When FGF >5-8L/min in the circle system, how much CO2 reliance is on the absorbents?

Back 58

Very little because exhaled CO2 is rapidly diluted d/t the increased FGF and is sent to the scavenger

Front 59

When the granules of the CO2 absorbent are almost exhausted, what should you do?

Back 59

Do not increase VE, because the pt will inspire more of a CO2 mixture, but you should increase the FGF and change the absorbent at the end of the case

Front 60

What are some disadvantages to using the prefilled CO2 canisters?

Back 60

Many defective prepackages and if plastic shipping isn't taken off, it will not work

Front 61

What are some disadvantages to bulk absorbents?

Back 61

Free granules fr bulk can create a leak if they lodge between the clear plastic canister and the O-ring gasket of the absorber

Front 62

What are the two most commonly used CO2 absorbents?

Back 62

Soda lime and calcium hydroxide...soda lime is most widely used

Front 63

Choose the 4 components of soda lime.
a. Calcium hydroxide
b. Magnesium hydroxide
c.Water
d. Na hydroxide
E. K hydroxide

Back 63

Calcium hydroxide (80%), Water(15%), Na hydroxide( 4%), and K hydroxide(1%)

Front 64

What is added to the absorbent to make it harder and more stable?

Back 64

Small amts of silica are added to produce calcium and sodium silicate

Front 65

Chose the catalyst for the CO2 absorptive properties of soda lime.
a.Potassium hydroxide
b.Sodium hydroxide
c. Magnesium hydroxide

Back 65

b. sodium hydroxide

Front 66

Which CO2 absorbent is implicated as as agent that may cause OR fires if used with sevo?

Back 66

Barylime

Front 67

What is the major advantage of using the new calcium hydroxide lime over other agents?

Back 67

Its lack of strong bases sodium and potassium hydroxide (uses calcium chloride and polyvinylpyrrolidine instead)

Front 68

What does sodium and potassium hydroxide in CO2 absorbents potentially produce?

Back 68

CO production and nephrotoxic substance, Compound A

Front 69

What are two disadvantages of using Calcium hydroxide in CO2 absorbents?

Back 69

1. Less absorptive capacity-50% less than others containing strong bases
2. Higher cost

Front 70

Describe the influence of smaller vs larger granules in the CO2 absorber.

Back 70

Smaller the granule, the greater the surface area available for absorption. However, as particle size decreases, airflow resistance increases. 4-8 mesh is the size in which absorptive surface area and resistance to flow is optimized.

Front 71

What are 5 factors that lead to an increase in the concentration of Compound A when using Sevo?

Back 71

1. low-flow or closed circuit anesthisia
2. use of baralyme rather than soda lime
3. higher absorbent temps
4. fresh absorbent
5. higher sevo in anesthetic circuit

Front 72

Which inhaled anesthetic interacts with CO2 absorbents, and what forms from the interaction?

Back 72

Sevoflurane, produces Compound A